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5cm X 5. 0 cm Jika lebih dari 2 Tanggungan sila sertakan Borang DP11A baru / If more than 2 dependants please attach new DP11A Form. C. JABATAN IMIGRESEN MALAYSIA IMMIGRATION DEPARTMENT OF MALAYSIA MAKLUMAT TANGGUNGAN / DEPENDANT INFORMATION DP11A DP11A Tandakan X Dalam Petak Berkenaan / Mark X in Approriate Box A. MAKLUMAT PRINSIPAL / PARTICULARS OF PRINCIPAL Jenis Permohonan Type Of Application 1. No* Rujukan / Reference No* 2. No* Paspot / Passpot No* 3. Nama Prinsipal / Principal Name Baru / New Lanjutan / Extension Jenis Pas / Type Of Pass Pas Tanggungan / Dependent Pass 3. Tempoh Sah laku Pas / Validity Of Pass / Pas Lawatan Sosial untuk Tanggungan / Social Visit Pass Kod Hubungan / Relationship Code Pas Penggajian / Employment Pass 01 - Bapa/ Father Pas Lawatan Kerja Sementara / Visit Pass Temporary Employment 02 Ibu /Mother 03 Anak / Children 05 - Suami / Isteri / Husband /Wife 1. Warganegara / Nationality 2. Nombor Pasport / Passport No* 06 - Common Law Wife 07 - Anak Tiri / Step Children 3. Nama Penuh / Full Name 09 - Lain-lain / Others 10 Pembantu Rumah / Maid 4. Jantina / Gender Lelaki / Male Lain - lain / Others Perempuan / Female VDR Tempat / Place 5. Hubungan / Relationship Sila masukkan kod hubungan yang disediakan / Please choose the relationship code provided 6. Tarikh Lahir / Date of Birth 7. Tarikh Tamat Pasport / Date of Expiry JP Visa 8. Tempat Dikeluarkan / Place of Issue 9. Tarikh Dikeluarkan / Date of Issue 10. No Pasport Lama / Old Passport No* 11. Tarikh masuk Malaysia / Date of present entry Pas Khas / Special Pass Cooling Off Period Pinda Tempoh Sahlaku Pas / Amendment To Validity Of The Pass Pindah Pas / Transfer Endorsement Lain-lain Sila Nyatakan Others Please State Paste A Photo Of Dependant Tampal Sekeping Gambar Tanggungan 3. AKUAN / DECLARATION Saya memperakui bahawa maklumat / kenyataan di atas adalah benar I hereby declare that the particulars / informations furnished above are true Tandatangan Prinsipal/Majikan/ Signature of Principal/Employer Nama Penuh / Name Cop Syarikat No* KPT / No* Paspot / I/C. JABATAN IMIGRESEN MALAYSIA IMMIGRATION DEPARTMENT OF MALAYSIA MAKLUMAT TANGGUNGAN / DEPENDANT INFORMATION DP11A DP11A Tandakan X Dalam Petak Berkenaan / Mark X in Approriate Box A. MAKLUMAT PRINSIPAL / PARTICULARS OF PRINCIPAL Jenis Permohonan Type Of Application 1. No* Rujukan / Reference No* 2. MAKLUMAT PRINSIPAL / PARTICULARS OF PRINCIPAL Jenis Permohonan Type Of Application 1. No* Rujukan / Reference No* 2. No* Paspot / Passpot No* 3. Nama Prinsipal / Principal Name Baru / New Lanjutan / Extension Jenis Pas / Type Of Pass Pas Tanggungan / Dependent Pass 3. No* Paspot / Passpot No* 3. Nama Prinsipal / Principal Name Baru / New Lanjutan / Extension Jenis Pas / Type Of Pass Pas Tanggungan / Dependent Pass 3. Tempoh Sah laku Pas / Validity Of Pass / Pas Lawatan Sosial untuk Tanggungan / Social Visit Pass Kod Hubungan / Relationship Code Pas Penggajian / Employment Pass 01 - Bapa/ Father Pas Lawatan Kerja Sementara / Visit Pass Temporary Employment 02 Ibu /Mother 03 Anak / Children 05 - Suami / Isteri / Husband /Wife 1. .

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